In a digital media briefing, Western Cape Premiere Alan Winde said that the province had still not exited its third wave of COVID infections.
With an R value of 0.9, this was the first time in the third wave that the value was below 1. However, this could be due to testing delays caused by the long weekend. Indeed, a sharp daily increase in national COVID cases has been recorded as of Thursday’s latest data, with the NICD reporting a 90% jump to 14 271. Overall case positivity still hovers above the 20% mark at 22.52%.
Cases continue to spike While overall cases in the Western Cape are plateauing, spikes in certain areas are seeing higher case rates than in the peak of the second wave. Oxygen is still being used as fast as it can be produced in the province, being supplemented by an additional 22 tonnes per day by truck deliveries from other provinces. A total of 3665 patients are in acute hospitals, with 99% occupancy in Metro areas. The Metro area is seeing a week-on-week case rise of 7%, which points to a plateau.
Vaccines proving effective – even against beta The Johnson & Johnson vaccine however is proving effective, with 91-95% protection against death and 65-66% protection against hospitalisation. With regard to variants, the vaccine confers 67% protection against hospitalisation when beta is dominant and 71% where delta is dominant.
The Western Cape’s vaccination programme remains on track, with 287 000 doses of Pfizer and 28 800 J&J doses to arrive today, Friday 13th.
Elsewhere, with 31.2 new cases per 100 000 people, KwaZulu-Natal may be becoming a COVID hotspot.
A further 473 people have died from COVID, bringing the official death toll to 76 247.
A UK study has furthered the understanding of the novel blood-clotting condition associated with the Oxford/AstraZeneca vaccine.
Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is characterised by a blockage of veins and a marked platelet reduction. The rare condition was first identified in the UK by Professor Marie Scully (University College of London Institute of Cardiovascular Science), also a Consultant Haematologist at UCLH, and Dr Will Lester from University Hospitals Birmingham NHS Foundation Trust.
The cases were presented by 182 consultant haematologists, and builds on understanding about the condition outlined in an April 2021 NEJMpaper led by Professor Scully.
Meanwhile, a study led by Dr Richard Perry (UCL Queen Square Institute of Neurology and UCLH) published in the Lancetearlier this month provided the most detailed observations so far of cases of cerebral venous thrombosis (CVT). one of the commonest and severest manifestations of VITT.
The overall mortality rate of those presenting to hospitals with definite or probable VITT was 23%, the paper reported. The condition almost entirely manifested between five and 30 days after their first vaccination, with no sex differences seen, and no predisposing prior medical conditions.
The chances of death increased significantly the lower the platelet count and the greater the activation of the blood clotting system, increasing to 73% in patients with a very low platelet count and intracranial haemorrhage following blood clots in the brain.
Overall, 41% of patients had no previous medical diagnoses and 85% were less than 60 years old. Overall incidence in individuals under 50 was estimated to be 1 in 50 000 – in line with reports from other countries.
Though optimal treatment was still uncertain, it was being continually refined in real time, the researchers wrote. For instance, the introduction of the use of plasma exchange in the most severe cases has led to survival rates that were significantly better than would be predicted based on baseline characteristics.
The research adds to evidence for use of non-heparin-based blood thinners to tackle blood clotting in cases of VITT, and that use of intravenous immunoglobin was associated with better outcomes.
Professor Scully said: “As a new condition we are still learning about how best to diagnose and manage VITT, but as time goes on, we have been able to refine our treatment approaches and improve rates of survival and chance of recovery. This continuous learning in real time has been made possible thanks to collaboration between colleagues across the UK.”
Lead author Dr Sue Pavord, at Oxford University Hospitals NHS Foundation Trust, said: “We have worked relentlessly to understand and manage this new condition, so that the hugely successful vaccine roll out can continue, which is the most viable solution to the global pandemic.”
A new study published in Science suggests that falls in metabolism occur much later in life, with a peak at a much younger age than anticipated.
“There are lots of physiological changes that come with growing up and getting older,” said study co-author Herman Pontzer, associate professor of evolutionary anthropology at Duke University. “Think puberty, menopause, other phases of life. What’s weird is that the timing of our ‘metabolic life stages’ doesn’t seem to match those typical milestones.”
Together with an international team of scientists, Prof Pontzer analysed the average energy expenditure of more than 6,600 people ranging from one week old to age 95 as they went about their daily lives in 29 countries.
Previously, most large-scale studies measured how much energy the body uses to perform basic vital functions. But that amounts to only 50% to 70% of the calories we burn each day. It doesn’t take into account the energy we spend doing everything else.
To come up with a number for total daily energy expenditure, the researchers relied on the “doubly labeled water” method, a urine test that involves having a person drink water with isotopes of hydrogen and oxygen and measuring how quickly these were flushed. This gold standard technique for measuring energy expenditure in humans outside the lab since the 1980s, but studies have been limited in size and scope due to cost. To overcome this, multiple labs pooled their data.
The research into energy expenditures revealed some surprises: compared to body weight, infants had the highest metabolic rates of all, rather than people in their teens or 20s as might be expected.
Energy needs shoot up during the first 12 months of life, and by their first birthday, a one-year-old burns calories 50% faster for their body size than an adult.
This comes from more than just tripling their birth weight in the first year. “Of course they’re growing, but even once you control for that, their energy expenditures are rocketing up higher than you’d expect for their body size and composition,” said Pontzer, author of the book, “Burn,” on the science of metabolism. “Something is happening inside a baby’s cells to make them more active, and we don’t know what those processes are yet,” Pontzer said.
After this initial surge in infancy, the data show that metabolism slows by about 3% each year until we reach our 20s, when it stabilises.
Teenagers, despite their growth spurt, did not result in an uptick in energy intake once weight was accounted for. “We really thought puberty would be different and it’s not,” Pontzer said.
Midlife was another surprise, with a thickening waistline from the 30s often ascribed to a changing metabolism, but the results show other factors are responsible.
In fact, the researchers discovered that energy expenditures from the 20s to 50s were the most stable. Even during pregnancy, a woman’s calorie needs were no more or less than expected given her added bulk as the baby grows. Metabolism only declines after age 60, and only by 0.7% a year. A person in their 90s needs 26% fewer calories than one in midlife.
Lost muscle mass explains part but not all of the picture. “We controlled for muscle mass,” Pontzer said. “It’s because their cells are slowing down.”
The patterns held even when differing activity levels were taken into account.
Energy expenditure changes have been difficult to analyse because so much else is going on, Prof Pontzer said. But the research supports the idea that it’s more than age-related changes in lifestyle or body composition.
“All of this points to the conclusion that tissue metabolism, the work that the cells are doing, is changing over the course of the lifespan in ways we haven’t fully appreciated before,” Prof Pontzer said. “You really need a big data set like this to get at those questions.”
Recent advances in the development and testing of plant-made vaccines has rekindled interest in plant-produced pharmaceuticals, including edible drugs, for human use. Technology and manufacturing advances could boost the uptake of such therapeutics, wrote Hugues Fausther-Bovendo and Gary Kobinger in an article published in Science.
Currently, therapeutic proteins such as antibodies, hormones, cytokines, and proteins in vaccines are mostly produced in bacteria or eukaryotic systems, including chicken eggs and mammalian or insect cell cultures. In 1986, scientists proposed the use of plants for the production of these proteins in what is termed ‘molecular farming’. Such a production process can be less costly and produce fewer contaminants.
Thus far, just one therapeutic protein derived from plants for human use has been approved (in 2012, for Gaucher disease). More recently in 2019, a plant-produced influenza virus vaccine completed phase III clinical trials with promising results, and phase III trials for a plant-made vaccine COVID vaccine started in early 2021. Plant-produced proteins have a number of advantages for vaccine development, according to Fausther-Bovendo and Kobinger, in particular the strong immune response the plant components of virus-like particles in vaccines can generate, which may reduce the need for adjuvants.
Also interesting to consider are oral, plant-made therapeutics, said Fausther-Bovendo and Kobinger. Possibly needing minimal processing, they could avoid expensive, lengthy manufacturing.
Edible vaccines – still predominantly in the preclinical stage of development – are also currently under development, the authors note. Compared to the proof-of-concept edible vaccines first tested decades ago, which generated weak immune responses, newly developed edible plant-made vaccines are now capable of provoking stronger immune responses, thanks to improved technology.
Because doses for therapeutics are much higher than for vaccines, investment in manufacturing infrastructure must increase to achieve large-scale manufacturing of plant therapeutic products, Fausther-Bovendo and Kobinger said.
In contrast to popular belief, most children diagnosed with attention deficit hyperactive disorder (ADHD) do not in fact outgrow the disorder according to a new study in the American Journal of Psychiatry. Instead, it manifests itself in adulthood in different ways over a lifetime, increasing and decreasing.
“It’s important for people diagnosed with ADHD to understand that it’s normal to have times in your life where things maybe more unmanageable and other times when things feel more under control,” said lead researcher Margaret Sibley, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a researcher at Seattle Children’s Research Institute.
Decades of research characterise ADHD as a neurobiological disorder typically first detected in childhood that persists into adulthood in approximately 50% of cases, but this study found that only 10% of children completely outgrow it.
“Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in the Multimodal Treatment Study of ADHD continued to experience residual symptoms into young adulthood,” they wrote.
ADHD is characterised by two main clusters of symptoms: inattentive symptoms which look like disorganisation and forgetfulness, and also the hyperactive, impulsive symptoms. In children, those symptoms look like having a lot of energy, such as running around and climbing on things. In adults, it manifests more as verbal impulsivity, difficulty with decision-making, and not thinking before acting. The disorder affects people differently and looks different depending on the phase of life.
Some people with ADHD also report a unique ability to hyper-focus, as in some Olympic athletes. While many people may experience symptoms similar to ADHD, it is estimated the disorder roughly affects 5% to 10% of the population, said Sibley.
This study followed a group of 558 children with ADHD from 8-years old to 25 years-old. Every two years, the cohort had assessments to determine whether they had symptoms of ADHD. Family members and teachers were also asked about their symptoms.
According to Prof Sibley, the belief that 50% of children outgrow ADHD was first put forward in the mid-1990s. Most studies, she said, only re-connected once when the kids reached adulthood and weren’t able to see if the ADHD had really gone away.
Coping with ADHD Researchers have yet to find what causes ADHD to flare. Prof Sibley said it could be stress, the wrong environment, and not having a healthy lifestyle of proper sleep, healthy eating, and regular exercise. Also, if a person is not taking the time to manage symptoms and really understand what works best for them, then the symptoms are probably going to get more out of control, she said.
The two main treatments for ADHD are medication and therapy, though people can pursue their own healthy coping skills as well, said Prof Sibley.
Researchers found that most people who technically no longer meet criteria for ADHD in adulthood still retained traces though they were coping well.
“The key is finding a job or a life passion that ADHD does not interfere with,” Prof Sibley said. “You are going to see a lot of creative people have ADHD because they’re able to be successful in their creative endeavors despite having ADHD, whereas people who might be required to do very detail-oriented work at a computer all day—that could be a really hard combination for a person with ADHD.”
Prof Sibley said the time to seek professional help is when the symptoms cause problems in life, including not performing at one’s best, interpersonal problems, and inability to complete basic daily tasks.
Researchers have found that, coupled with MRI, the novel Stockholm3 blood test, could greatly cut overdiagnoses and thereby improve prostate cancer screening. The same research group previously showed that Magnetic resonance imaging (MRI) could also reduce overdiagnoses, and the Stockholm3 test can reduce the number of MRIs performed by a third while further preventing the detection of minor, low-risk tumours.
“Overall, our studies show that we have identified the tools needed to be able to carry out effective and safe screening for prostate cancer. After many years of debate and research, it feels fantastic to be able to present knowledge that can improve healthcare for men,” said Tobias Nordström, associate professor of urology at the Department of Clinical Sciences, Danderyd Hospital at Karolinska Institutet, who is responsible for the STHLM3MRI study.
The disease is currently screened for by using PSA (prostate-specific antigen) tests combined with traditional biopsies, result in unnecessary biopsies and overdiagnosis from detection of numerous minor, low-risk tumours. As a result of these costs outweighing benefits, no country save Lithuania has implemented nationwide screening programmes.
Results from the STHLM3MRI study published in NEJM indicated that overdiagnosis could be reduced by substituting traditional prostate biopsies with magnetic resonance imaging (MRI) and targeted biopsies. The new results, now published in y, show that the addition of the Stockholm3 test, which was developed by researchers at Karolinska Institutet, can be an important complement. It is a blood test that uses an algorithm to analyse a combination of protein markers, genetic markers and clinical data.
Fewer biopsies needed “The availability of MRI in healthcare will be a limiting factor. We now show that a novel blood test as adjunct to MRI can reduce the number of MRIs performed by a third. Compared with traditional screening, overdiagnosis is reduced by as much as 69 percent. At the same time, the number of biopsies is halved, while we can find just as many clinically significant tumours,” said Martin Eklund, associate professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
In the STHLM3MRI study, 12 750 male participants provided an initial blood sample for PSA analysis and analysis using the new Stockholm3 test. Men with test results showing elevated PSA levels were then randomly selected for traditional biopsies or MRI. In the MRI group, biopsies were conducted strictly on suspected tumours identified by MRI.
“Separate use of the Stockholm3 test and MRI has previously been shown to be cost-effective. We have now analysed the cost-effectiveness when these tools are combined and will shortly report exciting results from that analysis,” Tobias Nordström concluded.